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922-111 exam Dumps Source : Communication Server 1000 to Rls. 6.0 Upgrades for Technicians
Test Code : 922-111
Test Name : Communication Server 1000 to Rls. 6.0 Upgrades for Technicians
Vendor Name : Nortel
: 27 Real Questions
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newsNortel, Microsoft Add to Joint Unified Communications Line
The products are part of the agencies' innovative Communications Alliance, which now presents 10 products jointly developed via each corporations, the announcement stated.
The four new choices are:
"With these options, corporations can now choose to install unified communications by the use of a client premise solution, managed carrier solution, or hybrid of the two, helping accelerate the pace of unified communications adoption," Ruchi Prasad, vice president and normal manager, resourceful Communications Alliance, Nortel, talked about in an announcement asserting the items.
in line with the agencies, these releases imply the partnership has now delivered on all the products it at first promised when it changed into introduced in January 2007. each organizations intend to continue to work together on new UC solutions.
"in the coming yr, they can prolong the scope of their unified communications collaboration to consist of areas corresponding to Contact middle integration and a mix of hybrid and completely hosted UC options," commented Gurdeep Singh Pall, company vice chairman, Unified Communications community, Microsoft, within the same liberate.
Becky Nagel is the vice chairman of web & Digital strategy for 1105's Converge360 neighborhood, the place she oversees the front-conclusion web team and deals with all points of digital approach. She also serves as government editor of the neighborhood's media internet websites, and you'll even discover her byline on PureAI.com, the group's latest web site for enterprise builders working with AI. She currently gave a chat at a number one technical publishers convention about how alterations in net technology can also impact publishers' backside lines. observe her on twitter @beckynagel.
KPN has announced it's relocating its employee communications to an all IP-based mostly platform in line with Nortel's Communications Server a thousand. Roll-out of the new voice and multimedia capacity across KPN will ensue in phases beginning in February 2006. especially, KPN is the use of Nortel's Communications Server 1000 to provide 20,000 voice over IP clients. among these 20,000 employees an initial 12,000 employees will even be the usage of Nortel's Multimedia Communications Server 5100 for voice, statistics, messaging, video and presence focus.
the use of Nortel's multimedia communications platform, KPN's employees will be in a position to use their PDAs, laptops and PCs for voice, quick message, file sharing, e mail and video conference purposes. KPN's worker communications could be additional superior by way of presence recognition. http://www.nortel.comemail This BlogThis! Share to Twitter Share to facebook
To support telephony-based mostly unified communications
Nortel, a company of networking products, has delivered the verbal exchange Server 1000 (CS a thousand) 6.0 to aid telephony-primarily based unified communications.
Nortel talked about that CS one thousand presents centralisation of capabilities which are expected to enable organisations to reduce the full charge of possession (TCO) of their network methods.
The company mentioned that the Unified Communications administration answer, a component of free up 6.0, manages CS one thousand as the community’s unified communications base and offers a framework that enables administration of converged community aspects.
The unencumber 6.0 additionally expands CS one thousand alternate options for COTS systems, including IBM x3350 and Dell R300.
The communication Server 1000 is a utility-primarily based IP PBX. It reportedly gives converged community and telephony aspects. dispensed over IP LAN and WAN infrastructure, it helps applications including unified messaging, client contact centre, interactive voice response, instant VoIP and SIP/IP telephony.
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Over 4,400 households to be relocated next year
HCMC has relocated 10,356 among 15,000 households (69%) living along canals across the city and will need an estimated VND4 trillion to relocate and compensate the remaining households, according to the HCMC Department of Construction.
The relocation of 15,000 households belongs to 26 projects in 14 districts throughout the city.
The remaining 4,428 households will be moved next year in three phases. They are categorized into three groups, with 483 households receiving compensation already, 1,194 households being compensated and over 2,700 others being processed to get compensation.
HCMC currently has around 5,000 unsold apartments and land lots at many projects. Of these, around 1,000 apartments have been converted into budget ones. Therefore, the city has virtually had sufficient housing for relocated households.
However, one problem that has arisen is that relocated households do not want to live far from their old homes.
HCMC vice chairman Nguyen Huu Tin has told the Department of Construction, the Department of Finance and district authorities to consider relocating groups of households to avoid affecting their livelihoods.
llegal sand mining boats seized
As many as 51 boats involved in illegal sand mining have been seized by police in the capital city's Phuc Tho District.
The operation, carried out by 200 policemen from the Ministry of Public Security netted records of illegal sales dating back many years, as well as weapons, indicating the possibility that gangs were protecting the illegal business.
Police said the boats are believed to have been directly mining sand from the river bed or filling their hulls at sand depots set up along the river banks during the night for quite some time.
Based on information provided by local residents, the police also arrested a few suspects believed to be leaders of a gang involved in the illegal mining operations.
High tides submerge Ca Mau’s coastal areas
High tides over the past few days submerged the entire 252km long coastline of the southernmost province of Ca Mau, with some areas under 0.5m of water.
According to Le Van Su, director of the provincial Department of Agriculture and Rural Development, high tides came early this year, and at a higher level than normal, which is a clear sign of climate change and rising sea water level. The tides in the province usually peak in the period from December to early March the following year.
Some areas 50km deep inside the mainland are also affected by the tides, including Nam Can town in Nam Can district.
More than 2,000 ha of aquaculture farms and 1,000 ha of food crops and orchards have been damaged by the intrusion of salt water.
Vice Chairman of the provincial People’s Committee Le Dung said the Prime Minister has approved five programmes aimed at adapting to climate change and coping with rising sea water level in Ca Mau. The programmes will need a total of 5 trillion VND (238 million USD) to implement.
According to the official, the province will give priority to the programme on building a sea dyke along its eastern coastline and upgrade the western dyke system at an investment of 1.3 trillion VND (61.9 million USD).
The western sea dyke system of Ca Mau has been affected by serious landslides caused by heavy rains and strong winds. The 120km-long system stretches through Phu Tan, U Minh and Tran Van Thoi districts in Ca Mau province to Kien Giang province. It plays a significant role in transportation, saltwater intrusion prevention and national security.
Businesses join efforts to minimise child fatality
A community called ZEROworkplace made debut in Ho Chi Minh City on November 10 with an aim of calling upon Vietnamese businesses to support activities minimising child fatality, including the ongoing measles-rubella vaccination campaign.
ZEROworkplace is part of efforts by the United Nations Children’s Fund (UNICEF) to promote the global campaign “Believe in ZERO”, which was launched in Vietnam in October 2013.
At the event, UNICEF Representative in Vietnam Youssouf Abdel-Jelil called for strong cooperation from the business circle to support the current measles-rubella vaccination campaign nationwide.
Deaths by measles and rubella are preventable by vaccination, and the national vaccination campaign needs to access all children, especially those from migrant families and in rural areas, he added.
This campaign is the first activity to receive assistance from ZEROworkplace, which will design online communication documents and organise meetings, arts performances and knowledge competitions to raise business employees’ awareness of the diseases.
Reports show that about 100 Vietnamese children die every day from preventable causes and “Believe in ZERO” is striving to reduce the number to zero.
ZEROworkplace aims to bring the business community towards the goal of ZERO by turning workplace into a platform that employees can access vital information relating to their children.
Pou Yuen Vietnam Ltd Co. and Viet Phu Payment Services Support Joint Stock Company (Mobivi), based in HCM City, are the first members of the community.-
Household utensil, gift fair launched
The 2014 Household Utensil and Gift Fair opened in Hanoi on November 10 with the participation of over 100 businesses.
On the display are foods and beverage, household appliances, apparel, electronic devices, decorations, handicraft items, souvenirs, healthcare products, cosmetics, jewellery, shoes and handbags.
Baking competitions are organised during the event.
The annual fair is to introduce products to local consumers, develop the distribution system and connect producers and consumers.
It also provides a platform for businesses to share experience and seek for partnerships.
The fair will last November 16.
Bac Giang province honours outstanding farmers
The Farmers’ Union in the northern province of Bac Giang held a ceremony on November 10 to honour outstanding farmers in the locality’s three-year emulation campaign on promoting production and reducing poverty.
A total of 132 units, households and individuals were praised for their forward thinking in applying scientific and technical advances to production and business as well as in adapting to the market economy, thus becoming rich themselves and helping others escape from poverty.
They are the best among thousands of the union’s members who are operating more than 116,000 production and business establishments with high economic values, generating incomes from hundreds of millions of dong to billions of dongs each year.
Some of the model farmers are Vu Duy Kiem in Luc Ngan district who grows several types of quality orange and earns around 1.7 billion VND (81,000 USD) a year, and Nguyen Van Duoc from Hiep Hoa district, whose pig farm brings him 1 billion VND (47,600 USD) each year.
Bac Giang province endeavours to improve public administration
The northern province of Bac Giang is committed to improving its Provincial Governance and Public Administration Performance Index (PAPI) in a bid to create a transparent and effective administrative apparatus.
PAPI is a policy tool that measures the administration and governance efficiency of the State administration system in Vietnam’s 63 provinces and cities.
It evaluates six different dimensions of provincial governance and public administration, including citizen’s participation at the local level, transparency, accountability, the control of corruption in the public sector, public administrative procedures, and the provision of public services.
In 2013, the index was compiled based on the responses of 13,892 citizens from all over the country. Bac Giang was ranked last.
Chairman of the provincial People’s Committee Bui Van Hai said Bac Giang aimed to increase its PAPI score to average or higher from 2014 onwards.
A higher PAPI score is important since it improves the interactions between local authorities and citizens, thus consolidating people’s confidence, he added.
To realise these targets, the official ordered relevant committees and departments to seriously implement people-focused measures.
The telephone numbers and e-mail addresses of heads of authorised agencies will be publicised to make it easier for citizens to voice their opinions on the State and local policies and laws. Optimal conditions will also be created to give residents more opportunities to contribute to local socio-economic development plans as well as land, construction and investment management plans, amongst others.
Chairman Hai also demanded the enhancement of corruption control in the public sector, reforming administrative procedures, improving public services, and promoting the accountability of local authorities to citizens.
The People’s Committees at district and communal levels were also requested to organise monthly meetings to update residents on the latest policies and respond to matters of concern. Additionally, officials and public servants at all levels were asked to engage with local residents at least once a month in order to timely receive and deal with people’s opinions.
US training project on cleaner production underway in Vietnam
The US Dow Chemical Company is financing a training project on cleaner production and waste management in Vietnam to help local businesses create environmentally friendly products.
The Vietnam Centre for Environment and Clean Production under the Ministry of Industry and Trade provided technical assistance and sent experts to support the training courses in cities and provinces.
As many as 23 drills were held throughout the country with the participation of 1,551 enterprises, mainly operating in highly-polluting industries such as coal, cement and rubber.
The courses aimed to enhance businesses’ capacity to use natural resources and energy efficiently, recycle material for production, and mitigate their environmental impact.
The courses introduced participants to the application of production methods adapted to their operational scale with little investment costs.
The beneficiaries also learnt about building and managing databases on material production and consumption, as well as renewing and upgrading clean technology.
A number of awareness-raising campaigns were launched to increase businesses’ understanding of the importance of environmental protection and the application of cleaner production techniques to reduce waste and production costs.
Experts advised the Government to promote cleaner production methods amongst the business community, especially small- and medium-sized enterprises; to support initiatives on environmental protection; and develop competent experts in the field.
Further recommendations included adopting policies that encourage businesses to apply environmentally friendly production methods and helping them devise safe solutions to reduce possible risks and damage.
Quang Ninh calls for investment in herbal medicine production
The northern province of Quang Ninh called for investments in the application of science and technology in herbal medicine production during a conference in Ha Long city on November 9.
According to Truong Quoc Cuong, head of the Medical Management Department at the Ministry of Health, more than 4,000 out of Vietnam ’s 12,000 flora species have medicinal properties, making Vietnam a medicinal plant hub in Southeast Asia .
Nearly 60,000 tonnes of herbal medicine is used in Vietnam every year, while the country only has the capacity to produce around 15,600 tonnes and imports the rest from other countries, including China and Singapore , he noted.
Cuong said Vietnam should make full use of its abundance of medicinal plants to boost its pharmaceutical sector.
Deputy Minister of Health Le Quang Cuong said maximising Vietnam ’s advantage in medicinal plants was one of the key components of the national strategy on the development of the pharmaceutical sector until 2020 with a vision to 2030.
The strategy states that by 2020 Vietnam should meet 20 percent of the demand for pharmaceutical materials, and meet 80 percent of the total domestic demand for medicine, with 30 percent of medicine made from medicinal plants, he said.
Currently, Vietnam has to import nearly 90 percent of its materials needed by the medical sector, he noted.
He also pointed out a number of shortcomings in the cultivation and exploitation of medicinal plants in Vietnam , including the unsustainable harvesting of medicinal plant resources, and a lacking application of appropriate science and technology in the production of herbal medicine.
The official said he hoped investors would get involved in the development of medicinal resources, thus providing more high-quality products to the market.
Quang Ninh has long been known for its medicinal plant resources thanks to its favourable natural conditions and expertise in using medicinal plants.
The province sells a large amount of herbal medicine on the domestic market, said Cuong.
At the conference, Quang Ninh announced the establishment of a steering committee for the creation of Yen Tu national garden to preserve and develop medicinal plants. It also granted licences to a number of investors in herbal medicine production.
Quang Ninh acts to improve tourism quality
The northern province of Quang Ninh set up a hotline to receive comments and proposals of domestic and foreign tourists on local tourism products in response to the “Ha Long Smile” programme.
Locals and visitors can contribute their ideas and suggestions via the hotline 0336.282.282 or email email@example.com . The opinions and responses will be published on the provincial portal, according to Vice Chairman of the provincial People’s Committee Le Quang Tung.
The local authorities hope the public’s suggestions will help the province come up with proper solutions to improve the quality of tourism products and services..
The “Ha Long Smile” programme was launched on November 1 with the message calling for the smile from the heart of every Quang Ninh citizen, thus turning the province into an ideal destination for tourists as well as for investors.
Ha Long Bay, which spans 1,553km2 and includes 1,969 islands of various sizes, was twice recognised as a UNESCO World Heritage Site in 1994 and 2000.
In 2011, Ha Long Bay outranked 261 other landscapes from all over the world and was voted one of the seven new natural wonders of the world.
It has recently been listed in the 20 geological wonders of the world by travel guide website Rough Guides.
Water plant project initiated to save polluted river
A project to grow water plants on To Lich River, one of the most polluted rivers in Hanoi, has been started with the hope it could save the ailing ecosystem.
To Lich River is considered by ecologists to be 'dead' because it has been severely polluted by the dumping of thousands of cubic metres of sewage water each day.
Recently, however, dozens of rafts covered with water plants were placed on the river. The rafts are made with pontoons and wood planks, which function to grow the plants. The rafts are anchored with ropes to stop them from floating away during storms or floods.
The roots of the plants on these floating gardens are expected to grow into the river, starting a process which would purify the water.
Not only do the plant rafts clean up the river, they also improve the scenery of the city. The locals said they were happy and optimistic about the project. Bui Thi Trang, a student in Hanoi said, "If this river becomes more clean, this area may have more pedestrians. And maybe the street will smell of flowers instead of the current stench."
Similar projects have been carried out in a number of other polluted rivers and lakes in Hanoi, such as Ngoc Khanh, Van Chuong and Giang Vo, with good results.Vietnam, Russia to cooperate in healthcare
Nguyen Tat Thanh University in HCMC on November 9 signed a deal with Russia’s Saint-Petersburg Electrotechnical University to implement a healthcare worker training program and set up a lab to teach Vietnamese students and workers to use medical equipment.
Demand for medical devices in HCMC and the country as a whole is huge, but healthcare workers lack skills and technology is obsolete compared to other regional countries.
Nguyen Tat Thanh annually trains 40-50 technicians at college level for hospitals and health centers.
The city government has allocated land at Saigon Hi-Tech Park (SHTP) in District 9 for the university to implement hi-tech health projects, paving the way for it to join hands the Russian educational institution to develop a workforce for the domestic healthcare sector.
Truong Xuan Lieu, former director of the HCMC Department of Health and president of the HCMC Medical Association, said human resources in the sector are limited while medical equipment and technology are outdated though the Government has invested heavily in hospitals and health facilities in the country over the years.
HCM City grants 17 ICT awards
The HCMC Department of Information and Communications on Saturday announced the results of the 6th annual HCMC Information and Communication Technology (ICT) Awards, with 17 awards going to enterprises, organizations and individuals.
According to the organizer, 46 organizations and one person registered for this year’s HCMC ICT awards.
The awards features six categories including enterprises having outstanding software solutions and products, businesses having the most popular hardware, companies providing the best value-added services, those having outstanding IT applications, organizations and individuals making outstanding contributions to the city’s IT development, and the best IT students.
Group 1, which honors enterprises having outstanding software solutions and products, includes Tinh Van Technologies Joint Stock Company for its electronic library software Libol 6.0, FAST Software Company with two awards for Fast Accounting 11, an accounting software for small and medium enterprises and its business management software ERP running on Web-Fast Business Online, MISA Joint Stock Company for its household registration management software (hotich.vn), and Intelligence Software Company for its software for business management and construction execution management Ibom v3.0.
Group 2 comprises the Integrated Circuits Design Research & Education Center of the Vietnam National University HCMC, Smart World Technology Ltd. Co., Saigon Track Joint Stock Company and Viettronics Tan Binh Joint Stock Company for their respective products of container monitoring system CTS-01, smart student card system sCampus, route monitoring device for automotive X200, and VTB desktop and server.
Enterprises providing the best value-added services in group 3 include Sao Bac Dau Technologies Group for its infrastructure services based on cloud computing, NAHI Joint Stock Company with NAHI Kid tablet, and Vietnam Data Communication Company (VDC) for its with digital signature certification service VNPT-CA and electronic billing services VNPT-Invoice.
The group of organizations having outstanding IT applications includes Vietnam Travel and Marketing Transport Joint Stock Company (Vietravel), Petroleum Trading Joint Stock Company (Petechim JSC) and Liksin Industry- Printing- Packaging Corporation.
Awards for organizations and individuals making great contributions to the city’s IT development went to Tran Ha Nam and HPT Vietnam Corporation.
The best IT students of the 6th HCMC ICT Awards are Nguyen Tri Hai from HCMC University of Technology, Le Yen Thanh, Dam Nguyen Trong Nhan, and Pham Duc Minh from HCMC University of Natural Sciences, and Pham Hoan Long from International University of Vietnam National University - HCMC.
IAEA shares experience in nuclear power infrastructure development
The International Atomic Energy Agency (IAEA) experts are sharing experience in building infrastructure for the development of nuclear power in Vietnam at a seminar in Hanoi from November 10-14.
The seminar aims to review the development of nuclear power infrastructure in Vietnam as recommended by IAEA, identify prioritised fields in the coming time and assist Vietnam in making plans to complete infrastructure for nuclear power development.
Deputy Minister of Science and Technology (MoST) Tran Viet Thanh said the Ministry will support cooperative activities between Vietnam and IAEA in using nuclear energy for peaceful purposes.
During the five-day seminar, the MoST and IAEA will discuss specific technical issues related to legal framework, nuclear power safety, radiation safety, human resources, effective response to nuclear incidents, radioactive waste and electric grid.
Speaking at the seminar, Park Jong Kyun, Director of the IAEA Division of Nuclear Power, committed that IAEA will continue to share experience and help Vietnam develop infrastructure for safe and secure nuclear power.
After discussing technical matters, the two sides will make a report on the actual development of nuclear power infrastructure in Vietnam and propose cooperative activities to achieve highest results in the coming time.
NGO begins new campaign to eradicate cleft palates
Around 1,000 Vietnamese and foreign volunteers, 5,000 children, and families will take part in a campaign called "the next era of smile" organised at 25 places around the country to mark Operation Smile's 25th anniversary.
The campaign will feature a series of events like screening for cleft palates, research studies, and medical conferences in which leading international medical experts will take part, and fund raising and awareness programmes.
There will be simultaneous cleft and dental screening from November 17 to 21 in the six cities and provinces of Ha Noi, Nghe An, Hue, HCM City, Bac Lieu, and An Giang, with doctors performing surgeries where required.
Operation Smile will also carry out the first ever comprehensive study in 41 provinces of the backlog of children born with facial deformities. Later it will draw up plans to provide free surgeries to eradicate the backlog and set up a system to monitor and track facial deformity rates amongst newborn babies.
The campaign, beginning this month, will go on until January.
Fundraiser in Czech Republic for disadvantaged people
A fundraising event was organised in Prague, the Czech Republic on November 9 to support disadvantaged people living in the European country.
The event marks the first anniversary of the “Mai Am Viet - Sec” (Vietnamese–Czech Home) Association, a charity in the Czech Republic.
Chairwoman Nguyen Thi Dung said the association visits orphanages and elderly care centres in the Czech Republic and in Vietnam on special holidays to give gifts and spend time with them.
The association also set up a group for elderly overseas Vietnamese aged 50 and above to provide mutual support.
After its first year of operation, the association has raised more than VND150 million (US$7,000) to support disadvantaged people. It now has 132 members.
The association also helps promote Vietnamese culture and cuisine in the Czech Republic.
40 outstanding works honoured at Innovative Youth Festival
As many as 40 research works and innovative products were honoured at the Innovative Youth Festival in Ho Chi Minh City on November 9.
Selected from 130 entries sent by 41 provincial and municipal Ho Chi Minh Communist Youth Union (HCMCYU) chapters, the winners covered a variety of aspects from socio-economy, health and education to security and defence.
Among those were the Ho Chi Minh City University of Medicine and Pharmacy’s research of Doxophylin used in asthma and COPD treatment, Viettel’s research on development foundation for military information device using SDR technology, and the natural rubber-based electric wire manufacturing project of the Vietnam Rubber Group.
Addressing the honouring ceremony, Nguyen Manh Dung, Permanent Secretary of the HCMCYU Central Committee, said that after ten years of operation, the “Innovative Youth” movement has inspired young people’s creativeness and promoted their great potential for the national industrialisation and modernisation.
The November 8-9 festival, organised by the committee, drew the participation of about 20,000 visitors, mostly students.
Safe walk for children
FedEx–Safe Kids Walk This Way (WTW) program was launched last week as part of the International Walk to School Month celebration in HCMC’s District 9.
Participants in the event were volunteers from FedEx and Safe Kids - Asia Injury Prevention Foundation (AIP), students, schools’ administrators, parents and representatives of the National Traffic Safety Committee, the Ministry of Education and Training, and local governments.
WTW is a road safety advocacy program aimed to increase the public awareness about safer walk for pedestrians in Vietnam. The program specially focuses on children as traffic accidents are one of the leading causes of their injury and death.
As part of the program, PhotoVoice is a photojournalism project aimed at encouraging 11,893 students from 12 secondary schools to take pictures of safe or dangerous road user behaviors and places. The initiative will run from this month to January 2015 with an aim to raise students’ understanding of pedestrian safety.
Other activities are Walk With FedEx, a series of road user workshops that will bring pedestrian safety education and equipment to 20,145 students in 18 primary schools throughout District 9 in HCMC and Safe School Zones where target schools in District 9 will undergo structural changes to improve the pedestrian environment for students.
Dr. Khuat Viet Hung, vice president of the National Traffic Safety Committee, said in a statement that the International Walk to School Month event in HCMC’s District 9 will enhance pedestrian safety education for children. “We are optimistic to see continued improvements in road safety for children in Vietnam,” he said.
Hung stressed that it is critically important for child pedestrians to learn to become safe road users and this is the responsibility of the Government, society, and families.
Inaugurated in Vietnam in 2010, Safe Kids Walk This Way has already reached more than 55,005 students from 70 primary and secondary schools with hands-on safety workshops and teaching sessions throughout the country.
FedEx has also installed a 1,700-square-meter traffic safety park in Dong Nai Province for primary school students as well as donated 3,472 helmets, 19,885 reflective jackets, and 46,446 pedestrian safety books to children.
The efficient management of operating suites requires careful resource management. Most expenses of a health care organization are personnel related (1), and successful management of medical personnel determines whether an operational unit is a revenue center or a cost center (2,3). Patient outcomes, particularly in anesthesiology, depend on the availability of expensive personnel, especially physicians (4,5). In a crisis, rapid mobilization of trained personnel is critical to successful resolution (6).
Mayo Clinic has a long history of efficient management of personnel, by which the knowledge and expertise of its physicians are leveraged through extensive use of allied health personnel. One strategy, implemented >100 yr ago, is the use of visual communication systems to direct physicians and allied health personnel to where they are needed. This began with the introduction of colored wooden door tabs. Each color denoted the state of a room. For example, a green tab indicated that the patient was in the room and ready to be seen by a nurse. A blue tab indicated that the patient was ready to be seen by a physician. A red tab indicated that help was needed for an emergency.
This communication strategy spread from the outpatient practice to the hospitals, including the operating suites. Subsequently, door tabs were replaced by colored electric lights. A chime was sounded when the state of a room changed. This communication strategy was thought to improve the efficiency and quality of care in the operative environment. In 1981, a new operating suite was opened at Saint Marys Hospital, 1 of 2 hospitals associated with Mayo Clinic. This prompted updating the communication technology at both hospitals. Electric lights were replaced with video displays suspended from the ceilings or mounted on the walls in the operating rooms (OR), procedure rooms, and support areas.
This Video Paging System (VPS) used alphanumeric codes to communicate the state of each patient care location (7). Pages were initiated by use of electromechanical switches in each OR, procedure room, and preoperative and postoperative location. When a switch was closed (by pushing a button), an alphanumeric code, designating both the location and the individual needed, would be displayed throughout the operative or procedural suite, and in every procedure room, hallway, recovery and waiting area, lounge, office, and cafeteria. In addition, an emergency code was incorporated to rapidly direct staff to a particular location when a cardiac arrest, airway emergency, or other critical event occurred.
Over time, several problems emerged with the VPS. The black-and-white monitors that displayed the pages burned in after about 18 mo, making the displays unreadable. Replacement monitors were costly and difficult to find. The software was difficult to maintain, and software constraints became unacceptable as the practice grew and evolved. When seven additional ORs were built at Saint Marys Hospital, and OR numbering changed from two digits to three digits, the VPS could not accommodate the change. These problems triggered the decision to replace the VPS with a new communication system.Design Criteria
Several types of devices were examined as possible solutions. Cell phones, digital pagers, and personal digital assistants were considered to possibly be less expensive and more flexible solutions than the existing hardwired approach. However, these options were rejected as being too dependent on personnel. If the paged individual did not respond, there would be no way to know whether the correct beeper was called, whether the person was unavailable, or to whom the page should be redirected. To respond to a page, one must interact with these devices, which can be impractical during procedures. It was concluded that a hands-free system would be designed and implemented.
With little review or documentation, the VPS had evolved on an ad hoc basis with additional functions and a broader geographic distribution. Missing comprehensive system documentation made determining where the current system was used and what information was transmitted challenging. A careful analysis of new requirements was completed, redundant and unnecessary functions were eliminated, and the geographic distribution of the new system was planned.
Prototyping technologic solutions occurred simultaneously. A distributed video architecture was rejected because of its inherent instability. Because the cathode-ray tube displays had only an 18- to 24-mo useful life, liquid crystal and light-emitting diode (LED) displays were considered. LED displays were chosen because they have a useful life of at least 15 yr and a greater luminosity that prevents washout from fluorescent and natural lighting. These displays are relatively expensive, but the cost can be amortized over a longer useful life. Choosing the size of the characters on the displays was a trade-off between the distance at which the displays could be read and the required information content. The size and information layout of the LED displays were determined by their expected placement, for example how low the displays could hang from hallway ceilings. The decision was made to develop in-house a configurable, centrally programmable keypad that would replace the electromechanical switches.
Several distribution architectures were considered. Use of the institutional Ethernet network was an attractive, inexpensive option, but pages could be delayed when network bandwidth demand was greatest. Because pages are time-sensitive, this risk was deemed unacceptable. Therefore, an independent Ethernet network was chosen to drive the system. The computer-based anesthesiology paging system (CAPS) was designed to be upgradeable and easily configured. Software running on standard hardware is more easily adaptable and requires fewer maintenance personnel. Use of commercially available components also reduces costs for development and maintenance (Fig. 1).System Specifications
The CAPS runs on dual-processor, redundant Compaq servers (Compaq Computer, Houston, TX) using SQL Server 7.0 under the Windows NT 4.0 operating system (Microsoft, Redmond, WA). Because the system is used as an emergency indicator, continuous availability is required. A redundant Central Processing Unit architecture satisfies this up time requirement. Software was written in Microsoft’s Visual Basic 6.0 and Visual C++ 6.0. The distribution architecture is a star pattern of Ethernet and RS-422 devices connected by standard Category-5 cable. Terminal servers connect the RS-422 protocol LED displays and the programmable keypads to the Ethernet network. The server can send daily electronic mail with system statistics and maintenance needs. The CAPS can send a page to a beeper for urgent maintenance problems (Fig. 1). The server software connects to the terminal server ports (one device per port) via device controllers. A simple network management protocol manager restarts failed connections without manual intervention.
The software design optimizes the handling of new pages to assure the shortest possible time between placing a page and seeing it on the LED displays. If there are no active emergency pages, all new pages are processed and displayed within 1.5 s. The user initiates a page by either pressing a dedicated microswitch (hot key) or entering a numeric code on the keypad (Fig. 2). The page is sent to the keypad controller via the terminal server. The keypad controller associates the page with a specific keypad, the keypad’s workgroup (e.g., neurologic anesthesia or vascular radiology), and other necessary information. The page is then presented via a Microsoft ActiveX Data Object call to the SQL Server database engine. The database determines what text is to be displayed on the LED displays and then forwards the text to the queue manager. The database then returns control to the keypad controller, which illuminates an LED above the activated hot key. If a page for a physician or nurse is initiated from an OR, a light above that room’s door illuminates as a wayfinding aid.
The queue manager determines the workgroups for a new page and inserts the new page either into those groups’ new-page queues or emergency queues. Although there are seldom >15 active calls, each queue may hold up to 100 calls. At 1.5-s intervals, the display controllers query the queue manager for the next page. The display controller then forwards that page to each display. If the page is displayed for the first time, a chime sounds. The current time, synchronized with the atomic clock in Boulder, CO, is displayed in the upper right corner, except when emergency pages are displayed. The display controllers then perform housekeeping chores (e.g., querying displays for functional status), during the remainder of the 1.5-s interval before querying the queue manager for the next page. After a page has been displayed once, it is placed in the active-page queue. The queue manager then cycles through this queue while any pages are active. Emergency pages are not placed in the active-page queue. When an emergency page is initiated, it is the only page shown on the LED displays, the light above the room door blinks, and the chime is sounded repeatedly until the page is answered. In the unlikely event that two or more emergency pages are active simultaneously, only the emergency pages are cycled until answered.
The central servers, terminal servers, operating system, and database are all commercial products. The LED displays were initially custom-made products, but the manufacturer has subsequently added them to their standard product line. These displays are located throughout the hospitals where anesthesia services are provided or anesthesia personnel congregate.
The programmable keypads were designed in-house and were assembled and tested under contract. The keypads can accept new embedded code downloaded from the server. This allows for remote reprogramming of the keypads without maintenance personnel physically interacting with each keypad (i.e., removing >450 keypads from the wall and reprogramming them with a laptop computer). Therefore, upgrading the keypads is rapid and cost-effective.
An administrative program and several specialized tools for maintenance personnel were developed. The administrative program’s graphical user interface masks the relational database’s complexity and presents a more simplified view of the system. Pages, devices, reports, and other aspects of the system can be managed without use of the development engineering group. This feature allows maintenance personnel to be trained technicians, thereby decreasing the total cost of ownership and freeing the development engineering staff for other projects.User Functionality
The CAPS presents two kinds of pages: 1) class page, which is a page for a class of individuals to come to a patient location, and 2) person page, which is a page for a specific individual to come to a multiple-patient location. Class pages have three parts. The prefix characters are alphabetic, denoting the work area (e.g., “N” for the north anesthesia area or “CL” for the catheterization laboratory). The middle characters denote the room number within that work group (e.g., “N 808” for room 808 in the north anesthesia area or “CL 109” for room 109 in the catheterization laboratory). The suffix character denotes the class of person needed in the room. Therefore, complete pages would be “N 808 A,” meaning that an anesthesiologist is needed in room 808 in the north anesthesia area, or “CL 109 N,” meaning that a nurse anesthetist is needed in room 109 of the catheterization laboratory. Person pages have two parts. The prefix denotes a multiple-patient location (e.g., “P” for postanesthesia care unit or “o” for outpatient recovery). The other characters are numeric, denoting the individual needed. Therefore, a complete person page would be “P49,” meaning that person “49” is needed in the postanesthesia care unit.
Using CAPS is reasonably straightforward. For example, if a resident physician in cardiac catheterization room 104 needs to confer with the attending anesthesiologist, the resident pushes the “Physician” button on the keypad mounted on the anesthesia machine (Fig. 3). An LED above the button illuminates, confirming that the page has been received. Every monitor throughout the cardiac catheterization suite, including the room initiating the page, displays “CL 104 A” in green and chimes briefly (Fig. 4). The page remains on the LED display for 1.5 s as the system cycles from page to page. A page cycles every 1.5 s until it is deactivated by a person; there is no timeout feature for pages. When the attending anesthesiologist enters the room and pushes the “Physician” button, the page is no longer displayed anywhere and the LED above the button turns off. If the resident considers the page to be urgent, the resident pushes the “Urgent” button (Fig. 3) and then the “Physician” button; “CL 104 A” would appear in orange and cycles with any other pages. If there is an emergency in the procedure room, the two side-by-side emergency buttons are pushed simultaneously (Fig. 3). This action persistently displays “CL 104 A” in bright red on every display in the catheterization laboratory, and a chime rings until the emergency buttons in the room are pushed simultaneously. In the unusual event of >1 simultaneous emergency page, the display will cycle from emergency page to emergency page every 1.5 s, sounding the chime persistently, until all emergency pages are deactivated.
This same basic feature is available throughout the environment of the CAPS. A hot key is pushed on the keypad and the defined page is displayed throughout the respective operating or procedural suite. Other examples of possible pages are shown in Table 1. The hot keys can vary from keypad to keypad. For example, in the operating suite, anesthesiologists and certified registered nurse-anesthetists are the only licensed providers with hot keys, whereas in the cardiac catheterization laboratory, a hot key pages registered nurses who provide sedation care. The system has the ability to add many additional pages through use of the numeric keys (Fig. 3). For example, by pressing “246” followed by the “Enter” key, a unique page can be displayed, such as “CL 104 MP” for medical photographer. The keypad screen (Fig. 3) displays the keyed page, confirming to the user that the page has been received. If >1 page is entered via the keypad, instead of the hot keys, the pages are cycled every 1.5 s on the keypad’s screen.
The LED displays are more useful than the VPS cathode-ray tube monitors, which displayed a maximum of only four black-and-white characters. Like the CAPS, the VPS prefix character designated the workgroup, two digits identified the room number, and the suffix character indicated the personnel being paged. The CAPS displays allow a prefix, a room identifier, and a suffix, for a maximum of 10 characters that can be illuminated in 1 of 3 colors. Rooms can be specified by numbers, short words, or abbreviations. Without the limitations of the VPS, formerly cryptic pages are now displayed in unambiguous text. Whereas “P888” in the VPS meant that the postanesthesia care unit was full, this page is now displayed unambiguously on the CAPS as “PACU FULL.”
When anesthesia and OR personnel hear the “new call” chime, they can glance at the display and read the new call. If they miss seeing the new page, the system offers shortcuts so one does not need to watch all the pages cycle through the display. Personnel indicators in the lower left corner of the display (Fig. 5) identify the class of individual required (e.g., anesthesiologist, nurse, or technician). Zone indicators in the upper left corner of the display identify the work areas that have active calls (e.g., “N” for north anesthesia and “B” for cardiovascular anesthesia). If an anesthesiologist responsible for the B zone hears a new page chime but misses seeing the new page, the anesthesiologist can glance at the display (Fig. 5) and observe that the new call was for someone else (e.g., if only “D” is seen in the upper left of the display, only D zone personnel have active pages). If “B” is in the upper left and if “A” is not in the lower left, then the anesthesiologist no longer needs to look at the display because the new page was for someone else. Pages are sorted numerically within the zone, so people need to watch the display only until the codes for their rooms are either displayed or passed over. The personnel and zone shortcut indicators are cumulative for all active pages and are displayed for all except emergency pages.Postimplementation Review
At Mayo Clinic, each of the two hospitals has a CAPS. During the first 6 mo of operation, there were 8 h of unexpected downtime. There were four additional hours of planned downtime for installing lower priority functions, downloading keypad corrections, installing operating system patches, and correcting miscellaneous problems. After this initial shake-down period, the CAPS was down a total of 14 min in 3 mo (i.e., 0.144 min/day). In contrast, the VPS was down an average of 28.3, 29.7, 21.9, and 16.8 min/day in 1996, 1997, 1998, and 1999, respectively. Starting in 2000, the reliability of the VPS began to deteriorate compared with its historic norms. The deterioration became another issue that helped initiate the CAPS project. Despite the difficulty of comparing old and new technologic systems, the data show that the CAPS is more reliable than was the VPS.Clinical Evaluation
During the installation of the CAPS, there was a brief period during which neither the VPS nor the CAPS was available in all areas. The VPS was removed in segments as the CAPS was installed, and beepers were used temporarily as a bridging communications medium. Anesthesiologists and nurse anesthetists have used beepers for many years for person-to-person communications, such as consultations and outside telephone calls, and as a means to reach individuals when they are outside of the video paging environment (e.g., intensive care units and hospital wards). Because departmental personnel were experienced and comfortable with beepers and telephones are mounted on every anesthesia machine, it was decided to use these devices during the transition from the VPS to the CAPS. This allowed comparison of the efficiency of using beepers with the efficiency of using the CAPS.
Observations of paging with beepers occurred during a 4-day period, 2 days at each hospital. Each day, different ORs were studied on the basis of the implementation schedule of the CAPS. Data were gathered from within a randomly selected OR by recording the time a page was initiated to a beeper (beginning as the number was being dialed) and the time the responder entered the room. Because of the limitation of being able to observe only 1 OR at a time and the rapid installation of the CAPS, relatively few pages with beepers were observed (n = 12), all of which were routine, nonurgent calls. When the study was designed, it was expected that there would be 6 days of installation per hospital and, therefore, 12 days of observation for gathering beeper response times. Unfortunately for the study, but fortuitous for the practice, installation took only 2 days per hospital, which reduced the expected number of observations. The original CAPS installation schedule allowed more time for system verification in each work area than was actually needed and so the time allotted for beeper observations was significantly reduced.
Similarly, observations for the CAPS occurred over a 4-day period, 2 days at each hospital. Data were gathered by recording the time a page appeared on the LED display, which was within 1.5 s of the time the button was pressed from within the OR, and the time the responder entered the room. Because the CAPS displays its pages on LED displays located throughout the surgical suite, several ORs could be observed simultaneously by watching the displays, and more data were collected (n = 57). No urgent or emergency pages were observed.
The median response time for anesthesiologists paged with a beeper was 2.78 min (range, 1.00–7.23 min). Problem pages did occur, including incorrect beeper numbers that were given to next-shift personnel, multiple pages that were made because the caller was not certain that the correct number had been dialed, and missed or ignored pages that required repaging. The median response times for anesthesiologists paged with the CAPS was 1.57 min (range, 0.30–7.20 min). Because of the CAPS design, none of the problem pages observed with the beepers were observed with the CAPS. These results are summarized in Table 2 and Figure 6. A logarithmic transformation was applied to the data to satisfy the distributional assumptions required for the two-sample Student’s t-test. The t-test of the transformed data showed a statistically significant difference between the response times with beepers and the response times with the CAPS (P = 0.021, t 67 = 2.36). The CAPS had a shorter response time for anesthesiologists than the beeper method.
Mayo Clinic anesthesiologists generally are responsible for more concurrent procedures than is common in an academic practice. For example, one anesthesiologist concurrently cares for two pediatric open-heart patients at Mayo Clinic, whereas the norm is one procedure per anesthesiologist at Duke and Stanford Universities (personal communication). Although there is no hard evidence that the CAPS directly allows for higher concurrency, the anesthesiology department and the institution have concluded that the CAPS is an important tool that allows for these ratios with safe delivery of anesthesia care. The reasoning is that when an anesthesiologist is busy caring for a patient in one location (e.g., placing a pulmonary artery catheter or inducing anesthesia) and is paged to another location, the page remains visible until it is answered. This prompts colleagues to answer the page, thereby ensuring that clinical problems are rapidly addressed. The system is used to indicate cardiac arrests and other emergencies, initiating an immediate response from many available personnel. The system is also used to page personnel in other services, such as the clinical laboratory, autotransfusion, surgical pathology, and housekeeping. By allowing communication with many groups, the CAPS can be used to manage procedural areas more efficiently.
The design of the system is consistent with the communication philosophy that has developed at Mayo Clinic in both inpatient and outpatient environments. Patient care sites are equipped with a communication tool that identifies the state of the room. For the anesthesiology practice, the state of the room reflects the personnel needs in the room. If an anesthesiologist is needed, a visual page is displayed throughout the work environment informing both the anesthesiologist and the practice as a whole that assistance is requested in the procedure room. The postimplementation review demonstrates that the CAPS is more reliable than the system it replaced, with an average downtime of less than one minute per day.
When comparing the CAPS with a system of beepers, which are the standard communication devices in many medical centers, the time to answer a page was statistically significantly less when the page was initiated using the CAPS than using a beeper and the opportunity for communication errors are eliminated. This study has a number of limitations. The sample size of beeper paging is small (n = 12). However, they have no reason to believe that these data are not representative of their beeper paging system. Also, although a statistically significant difference in response time was detected between the beeper system and the CAPS, the clinical relevance of this difference is unclear. The clinical relevance of 1.21 minutes response time depends on the clinical situation that prompted the page. If a page is initiated to discuss fluid management, it is unlikely that the observed shorter response time would make any difference. However, if the page is to secure assistance for an airway-related problem, then 1.21 minutes could make a significant difference.
Another limitation of the study is that patient outcome data were not recorded as part of their data collection. All the pages observed were for routine matters (e.g., anesthesia induction, emergence, or routine questions). No emergencies or urgent pages were recorded in either group. A review of the CAPS database shows that there were 7 emergency pages during April 2002 when the paging system covered 97 ORs, 5 recovery rooms, and >46 nonoperative anesthetizing locations. The emergency pages were answered in an average of 35 ± 23 seconds. However, there are no data to compare this with emergency response to beeper pages. A much larger study would have to be undertaken to demonstrate an effect on patient outcomes. Although such a study was considered, the anesthesiology practice concluded that it was unwilling to investigate the clinical effect of paging without the CAPS because of concerns for patient safety and practice efficiency.
The CAPS has a subtle effect on the environment of the operating suite because there is not a constant din of overhead audio pages. Instead, a brief chime announces a new page to the entire staff. Anesthesiologists in the ORs are not straining to hear garbled pages. Anesthesiology residents and certified registered nurse anesthetists are not waiting in frustration, wondering whether their pages have been heard. Pages are persistently visible on ubiquitous displays until answered.
Mayo Clinic is a large group practice (>1000 attending physicians), and it can be difficult to ensure accountability of all members in a large organization (8). One drawback of using beepers is that staff may ignore or forget pages. With the CAPS, everyone in the procedural suites can see pages and be aware of pages that are not answered. The primary value of Mayo Clinic is “the needs of the patient come first.” Adherence to this principle encourages staff to respond to unanswered pages. However, even with assistance from colleagues, a continual pattern of ignoring pages becomes apparent. The CAPS promotes assistance from colleagues when a staff member is occupied with another patient and inhibits a pattern of unanswered pages in a manner not recognized by the anonymity of beepers. As a result, staff members are reluctant to have their pages displayed longer than necessary, even though there is no visible duration associated with any given page. The practice-wide result is that staff attend to the needs of patients in a timely manner without authoritarian management measures.
The CAPS was designed to be a hands-free, reliable, and low-maintenance communication system. The system is more reliable than the VPS it replaced. The development and installation of the CAPS is associated with anesthesiologists responding more rapidly to paging with the CAPS than to paging with beepers. This may be associated with improved patient outcomes and greater OR efficiency.References 1. Marrin CA, Johnson LC, Beggs VL, Batalden PB. Clinical process cost analysis. Ann Thorac Surg 1997; 64: 690–4. 2. Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Anesthesiology 1995; 83: 1138–44. 3. DeRiso B, Cantees K, Watkins WD. The operating rooms: cost center management in a managed care environment. Int Anesthesiol Clin 1995; 33: 133–50. 4. Abenstein JP, Warner MA. Anesthesia providers, patient outcomes, and costs. Anesth Analg 1996; 82: 1273–83. 5. Silber JH, Sean KK, Even-Shoshan O, et al. Anesthesiologist direction and patient outcomes. Anesthesiology 2000; 93: 152–63. 6. Gaba DM, Howard SK, Fish KJ. Crisis management in anesthesiology. New York: Churchill-Livingstone, 1994: 5–47. 7. Ereth MH, Byer DE, Behrens TL, Tri JL. Computer-based video paging [letter]. J Clin Monit 1989; 5: 217–9. 8. McMahon FB, McMahon JW. Psychology: the hybrid science. Homewood, IL: The Dorsey Press, 1982: 615–6. Attention Authors!
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Submitting your manuscript online will mean that the time and expense of sending papers through the mail can be eliminated. Moreover, because their reviewers will also be working online, the entire review process will be significantly faster.
You can submit manuscripts electronically via http://www.rapidreview.com. There are links to this site from the Anesthesia & Analgesia website (http://www.anesthesia-analgesia.org), and the IARS website (http://www.iars.org).
To find out more about Rapid Review, go to http://www.rapidreview.com and click on “About Rapid Review.”© 2003 International Anesthesia Research Society Source
Anesthesia & Analgesia97(1):196-204, July 2003.Related Videos
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